Rheumatological mimickers of HIV infection. Part 1: involvement of the musculoskeletal system

This first part of the lecture summarizes current data obtained from studies of cohorts of HIV-infected patients presenting with clinical signs of musculoskeletal and skin involvement. The rheumatologic manifestations of HIV infection are diverse and, as shown in several studies conducted both before and after the widespread introduction of antiretroviral therapy, occur with varying frequency. This variability can complicate familiarity with the issue, particularly for early-career clinicians. According to the literature, the most observed conditions in the context of HIV infection include rheumatoid arthritis, reactive arthritis, HIV-associated arthritis and arthralgias, spondyloarthritis, and psoriatic arthritis. The present article also discusses the occurrence of osteoporosis and osteonecrosis in these patients. Furthermore, it reviews the classification of muscle involvement in HIV infection, with a focus on cases of rhabdomyolysis of various origins.

1. https://cr.minzdrav.gov.ru/view-cr/79_2

2. Adizie T, Moots RJ, Hodkinson B, et al. Inflammatory arthritis in HIV positive patients: A practical guide. BMC Infect Dis. 2016 Mar 1:16:100. doi: 10.1186/s12879-016-1389-2.

3. Ramos-Ruperto L, Busca C, Diez-Vidal A, et al. Martin-Carbonero L, Delgado-Hierro A, Bernardino JI. Prevalence and Temporal Trends of Autoimmune Diseases in People Living with HIV. AIDS Res Hum Retroviruses. 2023 Mar;39(3):130-135. doi: 10.1089/AID.2022.0090

4. Malyshenko OS, Raskina TA, Averkieva Yu V, et al. Articular syndrome in an HIV-infected patient. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2020;14(4): 161-64. (In Russ.). doi: 10.14412/1996-7012-2020-4-161-164

5. Ponomareva EYu, Shuldyakov AA, Anashchenko AV, Rebrov AP. The clinical manifestation of HIVinfection simulating rheumatic diseases. Nauchno-Prakticheskaya Revmatologiya. 2018;56(4):525-30 (In Russ.).

6. Reveille JD, Williams FM. Infection and musculoskeletal conditions: Rheumatologic complications of HIV infection. Best Pract Res Clin Rheumatol. 2006 Dec;20(6):1159-79. doi: 10.1016/j.berh.2006.08.015

7. Bukhanova DV, Belov BS. Joint damage in HIV positive patients. Meditsinskii sovet. 2018;(9):82-7. (In Russ.).

8. Saigal R, Chakraborty A, Yadav RN, Goyal LK. Rheumatological Manifestations in HIV-Positive Patients: A Single-Center Study. Adv Ther. 2020 Oct;37(10):4336-45. doi: 10.1007/s12325-020-01470-3

9. Lawson E, Walker-Bone K. The changing spectrum of rheumatic disease in HIV infection. Br Med Bull. 2012 Sep;103(1):203-21. doi: 10.1093/bmb/lds022

10. Fox C, Walke-Bone K. Evolving spectrum of HIV-associated rheumatic syndromes. Best Pract Res Clin Rheumatol. 2015 Apr;29(2): 244-58. doi: 10.1016/j.berh.2015.04.019

11. Lebrun D, Hentzien M, Cuzin L, et al. Epidemiology of autoimmune and inflammatory diseases in a French nationwide HIV cohort. AIDS. 2017 Sep 24;31(15):2159-2166. doi: 10.1097/QAD.0000000000001603

12. Stein CM, Davis P. Arthritis associated with HIV infection in Zimbabwe. J Rheumatol. 1996 Mar;23(3):506-11.

13. Azeroual A, Harmouche H, Benjilali L, et al. Rheumatoid arthritis associated to HIV infection. Eur J Intern Med. 2008 Oct;19(6): e34-5. doi: 10.1016/j.ejim.2007.09.020

14. Siva C, Brasington RD. Worsening of arthritis with antiretroviral therapy: the coexistence of rheumatoid arthritis and human immunodeficiency virus infection revisited. J Clin Rheumatol. 2001 Feb;7(1):42-6. doi: 10.1097/00124743-200102000-00010

15. Ndakotsu MA, Salawu L, Durosinmi MA. Relation between erythrocyte sedimentation rate, clinical and immune status in HIV-infected patients. Niger J Med. 2009 Apr-Jun; 18(2):208-10. doi: 10.4314/njm.v18i2.45067

16. du Toit R, Whitelaw D, Taljaard JJ, et al. Lack of specificity of anticyclic citrullinated peptide antibodies in advanced human immunodeficiency virus infection. J Rheumatol. 2011 Jun;38(6):1055-60. doi: 10.3899/jrheum.100713

17. Telles JP, Azevedo Grande M, Jurgensen A, et al. Rheumatic manifestations in brazilian patients with AIDS. Acta Reumatol Port. 2014 Apr-Jun;39(2):143-5.

18. Koryachkin VA. Complex regional pain syndrome. Travmatologiya i ortopediya Rossii. 2014;(3):147-56. (In Russ.).

19. Sipilä R, Kalso E, Kemp H, et al. Pain catastrophizing levels differentiate between common diseases with pain: HIV, fibromyalgia, complex regional pain syndrome, and breast cancer survivors. Scand J Pain. 2024 Nov 5;24(1). doi: 10.1515/sjpain-2024-0049

20. Reveille JD. Rheumatic manifestations of human immunodeficiency virus infection. In: Firestein GS, Budd RC, Sherin G, et al, editors. Kelley and Firestein’s Textbook of Rheumatology. 10th edition. Elsevier: Philadelphia; 2017. P. 1929-1942.

21. Mody GM, Parke FA, Reveille JD. Articular manifestations of human immunodeficiency virus infection. Best Pract Res Clin Rheumatol. 2003 Apr;17(2):265-87. doi: 10.1016/s1521-6942(03)00003-2

22. Medina F, Perez-Saleme L. Moreno J. Rheumatic manifestations of human immunodeficiency virus infection. Infect Dis Clin North Am. 2006 Dec;20(4):891-912. doi: 10.1016/j.idc.2006.09.002.

23. Santacruz JC, Mantilla MJ, Pulido S, et al. Reactive Arthritis or HIV-Associated Arthropathy: Is It Important to Differentiate Them? Cureus. 2024 Sep 20;16(9):e69788. doi: 10.7759/cureus.69788

24. Solinger AM, Hess EV. Rheumatic diseases and AIDS – is the association real? J Rheumatol. 1993 Apr;20(4):678-83.

25. Buskila D, Gladman D. Musculoskeletal manifestations of infection with human immunodeficiency virus. J Am Acad Orthop Surg. 2002 Sep-Oct;10(5):312-20. doi: 10.5435/00124635-200209000-00003.

26. Fox C, Walker-Bone K. Evolving spectrum of HIV-associated rheumatic syndromes. Best Pract Res Clin Rheumatol. 2015 Apr; 29(2):244-58. doi: 10.1016/j.berh.2015.04.019

27. Calabrese LH, Kirchner E, Shrestha R. Rheumatic complications of human immunodeficiency virus infection in the era of highly active antiretroviral therapy: emergence of a new syndrome of immune reconstitution and changing patterns of disease. Semin Arthritis Rheum. 2005 Dec;35(3):166-74. doi: 10.1016/j.semarthrit.2005.03.007

28. Mallon E, Bunker CB. HIV-associated psoriasis. AIDS Patient Care STDS. 2000 May; 14(5):239-46. doi: 10.1089/108729100317696

29. Montazeri A, Kanitakis J, Bazex J. Psoriasis and HIV infection. Int J Dermatol. 1996 Jul;35(7):475-9. doi: 10.1111/j.1365-4362.1996.tb01658.x

30. Bartlett BL, Khambaty M, Mendoza N, et al. Dermatological management of human immunodeficiency virus. Skin Therapy Lett. 2007 Oct;12(8):1-3.

31. Maurer TA, Zackheim HS, Tuffanelli L, et al. The use of methotrexate for treatment of psoriasis in patients with HIV infection. J Am Acad Dermatol. 1994 Aug;31(2 Pt 2):372-5. doi: 10.1016/s0190-9622(94)70175-x

32. Njobvu P, McGill P. Psoriatic arthritis and human immunodeficiency virus infection in Zambia. J Rheumatol. 2000 Jul;27(7): 1699-702.

33. Castillo RL, Racaza GZ, Roa FD. Ostraceous and inverse psoriasis with psoriatic arthritis as the presenting features of advanced HIV infection. Singapore Med J. 2014 Apr; 55(4): e60-3. doi: 10.11622/smedj.2014062

34. Morar N, Willis-Owen SA, Maurer T, Bunker CB. HIV-associated psoriasis: pathogenesis, clinical features and management. Lancet Infect Dis. 2010 Jul;10(7):470-8. doi: 10.1016/S1473-3099(10)70101-8

35. Kellner H, Füessl HS, Herzer P. Seronegative spondylarthropathies in HIV-infected patients: further evidence of uncommon clinical features. Rheumatol Int. 1994;13(5): 211-3. doi: 10.1007/BF00390270

36. White AJ. Mitochondrial toxicity and HIV therapy. Sex Transm Infect. 2001 Jun;77(3): 158-73. doi: 10.1136/sti.77.3.158

37. Emerole KCh, Pokrovskaya AV, Pilipenko VI. Wasting syndrome in HIV-infected patients. Terapevticheskii arkhiv. 2016;88(5):125-129. (In Russ.).

38. Authier FJ, Chariot P, Gherardi RK. Skeletal muscle involvement in human immunodeficiency virus (HIV)-infected patients in the era of highly active antiretroviral therapy (HAART). Muscle Nerve. 2005 Sep;32(3): 247-60. doi: 10.1002/mus.20338

39. Gupta A, Thorson P, Penmatsa KR, Gupta P. Rhabdomyolysis: Revisited. Ulster Med J. 2021 May;90(2):61-69. Epub 2021 Jul 8.

40. Noe MM, Jain AG, Shahid S, Majeed U. Severe Rhabdomyolysis as an Unusual Presentation of Primary Human Immunodeficiency Virus Infection. Cureus. 2018 Jul 24;10(7): e3041. doi: 10.7759/cureus.3041

41. Yakovlev AA, Musatov VB, Kostritskaya SS. Rhabdomyolysis developed in an HIV-infected patient on the background of long-term effective antiretroviral therapy. Vestnik SanktPeterburgskogo universiteta. Meditsina. 2014; (1):208-213. (In Russ.).

42. Ahmed M, Mital D, Abubaker NE, et al. Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies. Microorganisms. 2023 Mar 19;11(3):789. doi: 10.3390/microorganisms11030789

43. Biver E, Calmy A, Aubry-Rozier B, et al. Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis. Osteoporos Int. 2019 May;30(5): 1125-1135. doi: 10.1007/s00198-018-4794-0

44. Biver E. Osteoporosis and HIV Infection. Calcif Tissue Int. 2022 May;110(5):624-640. doi: 10.1007/s00223-022-00946-4

45. Baranek B, Wang S, Cheung AM, et al. The effect of tenofovir disoproxil fumarate on bone mineral density: a systematic review and meta-analysis. Antivir Ther. 2020;25(1):21-32. doi: 10.3851/IMP3346

46. Negredo E, Bonjoch A, Perez-Alvarez N, et al. Comparison of two different strategies of treatment with zoledronate in HIV-infected patients with low bone mineral density: single dose versus two doses in 2 years. HIV Med. 2015 Aug;16(7):441-8. doi: 10.1111/hiv.12260

47. Tang MJ, Alexander A, Hoy JF. Gender and sex considerations in HIV and bone health. Curr Opin HIV AIDS. 2023 Mar 1; 18(2):75-80. doi: 10.1097/COH.0000000000000780

48. Lin W, Li XF, Ren DC, et al. Administration of zoledronic acid alleviates osteoporosis in HIV patients by suppressing osteoclastogenesis via regulating RANKL expression. Mol Med. 2021 Feb 26;27(1):19. doi: 10.1186/s10020-021-00276-5

49. Wang JC, Chung SM, Wu PT, et al. Optimizing bone health in people living with HIV: insights from a network meta-analysis of randomized controlled trials. EClinicalMedicine. 2025 Feb 17:81:103103. doi: 10.1016/j.eclinm.2025.103103. eCollection 2025 Mar.

50. Rezamand G, Estevao MD, Morvaridzadeh M, et al. Effects of vitamin D supplementation on bone health and bone-related parameters in HIV-infected patients: a systematic review and meta-analysis. Clin Ther. 2022 Feb;44(2):e11-25.e8. doi: 10.1016/j.clinthera.2021.12.012

51. Allison GT, Bostrom MP, Glesby MJ. Osteonecrosis in HIV disease: epidemiology, etiologies, and clinical management. AIDS. 2003 Jan 3;17(1):1-9. doi: 10.1097/01.aids.0000042940.55529.93

52. Morse CG, Mican JM, Jones EC, et al. The incidence and natural history of osteonecrosis in HIV-infected adults. Clin Infect Dis. 2007 Mar 1;44(5):739-48. doi: 10.1086/511683

53. Mehsen-Cetre N, Cazanave C. Osteoarticular manifestations associated with HIV infection. Joint Bone Spine. 2017 Jan;84(1):29- 33. doi: 10.1016/j.jbspin.2016.04.004. Epub 2016 May 26.